Sweetman Alexander, Lechat Bastien, Catcheside Peter G, Smith Simon, Antic Nick A, O'Grady Amanda, Dunn Nicola, McEvoy R Doug, Lack Leon
The Adelaide Institute for Sleep Health and Flinders Health and Medical Research Institute: Sleep Health, Flinders University, Adelaide, SA, Australia.
College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.
Front Psychol. 2021 May 4;12:676763. doi: 10.3389/fpsyg.2021.676763. eCollection 2021.
Co-morbid insomnia and sleep apnea (COMISA) is a common and debilitating condition that is more difficult to treat compared to insomnia or sleep apnea-alone. Emerging evidence suggests that cognitive behavioral therapy for insomnia (CBTi) is effective in patients with COMISA, however, those with more severe sleep apnea and evidence of greater objective sleep disturbance may be less responsive to CBTi. Polysomnographic sleep study data has been used to predict treatment response to CBTi in patients with insomnia-alone, but not in patients with COMISA. We used randomized controlled trial data to investigate polysomnographic predictors of insomnia improvement following CBTi, versus control in participants with COMISA.
One hundred and forty five participants with insomnia (ICSD-3) and sleep apnea [apnea-hypopnea index (AHI) ≥ 15] were randomized to CBTi ( = 72) or no-treatment control ( = 73). Mixed models were used to investigate the effect of pre-treatment AHI, sleep duration, and other traditional (AASM sleep macrostructure), and novel [quantitative electroencephalography (qEEG)] polysomnographic predictors of between-group changes in Insomnia Severity Index (ISI) scores from pre-treatment to post-treatment.
Compared to control, CBTi was associated with greater ISI improvement among participants with; higher AHI (interaction = 0.011), less wake after sleep onset (interaction = 0.045), and less N3 sleep (interaction = 0.005). No quantitative electroencephalographic, or other traditional polysomnographic variables predicted between-group ISI change (all > 0.09).
Among participants with COMISA, higher OSA severity predicted a greater treatment-response to CBTi, versus control. People with COMISA should be treated with CBTi, which is effective even in the presence of severe OSA and objective sleep disturbance.
共病性失眠与睡眠呼吸暂停（COMISA）是一种常见且使人衰弱的病症，与单纯性失眠或睡眠呼吸暂停相比，其治疗难度更大。新出现的证据表明，失眠认知行为疗法（CBTi）对COMISA患者有效，然而，睡眠呼吸暂停更严重且有更明显客观睡眠障碍证据的患者对CBTi的反应可能较差。多导睡眠图睡眠研究数据已被用于预测单纯性失眠患者对CBTi的治疗反应，但未用于COMISA患者。我们使用随机对照试验数据来研究CBTi治疗后失眠改善的多导睡眠图预测指标，与COMISA参与者的对照情况进行比较。
145名患有失眠（根据国际睡眠障碍分类第三版[ICSD - 3]）和睡眠呼吸暂停[呼吸暂停低通气指数（AHI）≥15]的参与者被随机分为CBTi组（n = 72）或无治疗对照组（n = 73）。使用混合模型来研究治疗前AHI、睡眠时间以及其他传统指标（美国睡眠医学会睡眠宏观结构）和新指标[定量脑电图（qEEG）]等多导睡眠图预测指标对从治疗前到治疗后失眠严重程度指数（ISI）评分组间变化的影响。
与对照组相比，CBTi与以下参与者的ISI改善程度更大相关：AHI较高者（交互作用P = 0.011）、睡眠开始后觉醒较少者（交互作用P = 0.045）以及N3睡眠较少者（交互作用P = 0.005）。没有定量脑电图或其他传统多导睡眠图变量能够预测组间ISI变化（所有P>0.09）。
在COMISA参与者中，较高的阻塞性睡眠呼吸暂停严重程度预示着与对照组相比，对CBTi的治疗反应更大。COMISA患者应接受CBTi治疗，即使存在严重的阻塞性睡眠呼吸暂停和客观睡眠障碍，CBTi也是有效的。
